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[.Extract from the Baltimore Physician and Sfrgeon. Sept, i, 1874] 
A SELF-RETAINING VAGINAL SPECULUM, 
By Aug. F. Erich, M, D., 
Prof, of Diseases of Women, College of Physicians and Surgeons, Baltimore. 
The accompanying illustrations represent a self-retaining spec- 
ulum, a description of which was first published in the February 
number of the New York Medical Journal of 1869, by means of which 
the vagina and uterus may be exposed for all surgical purposes with- 
out the aid of an assistant. It is most conveniently used in Sims’ 
left lateral semi-prone position. The second wood-cut represents it as 
used with the patient upon her knees, this being the best position to 
show all the parts of the instrument in the illustration. This position 
is, however, rarely assumed in practice, as it is more fatiguing to the 
patient and less convenient to the operator. It exposes the interior of 
the vagina upon the same principles as Sims’ speculum, by retracting 
the perineum; the distension of the vaginal cavity being secured by 
placing the patient in such a posture as will cause the pelvic organs to 
gravitate from the retractor. Before the speculum is applied the patient ought to loosen such 
portions of her dress as may compress her abdomen, then put her 
head and right arm through the loop of the strap belonging to the 
speculum, and assume the position described by Sims, as follows: 
“The patient is to lie on her left side. The thighs are to be flexed at 
about right angles with the pelvis, the right being drawn up a little 
more than the left. The left arm is thrown behind across the back, 
and the chest rotated forwards, bringing the sternum very nearly in 
contact with the table, while the spine is fully extended, with the head 
resting on the left parietal bone. The head must not be flexed on 
the sternum nor the right shoulder elevated. Indeed, the position 
must simulate that on the knees as much as possible, and for this 
reason the patient is rolled over on the front, making it a left lateral 
semi-prone position.’’ 
The light should be derived from the lower portion of the window 
in front of which the patient is placed upon a table ; the upper portion 
of that window, as well as all other windows in the room, should be 
closed by blinds. Now oil the duck-bill retractor A and introduce it 
upon the index finger of the right hand, carrying it along the posterior 
wall of the vagina as far back as possible, then press its tip with the 
finger in the vagina towards the sacrum as far as the parts will yield 
to gentle pressure, and use the screw G to secure it in the position thus 3 
attained. Then place the fulcrum plate B over the centre of the 
sacrum and draw upon the lever H until the perineum is sufficiently 
retracted, and fix it in that position by attaching the strap L to the 
hooks at the upper end of the lever. The little guard plate shown 
in the wmod-cut is intended to cover the steel hooks when the instru- 
ment is not in use, to protect the fingers of the operator against 
accidental contact with them. Should there be lateral version 
of the uterus, the instrument can be adjusted to any lateral angle by 
the screw C. By means of this screw also the retractor may be 
detached, and others of different sizes secured to the levers. The 
uterus may be fixed in any desired position by tightening the screw D 
of the adjustable depressor O. It has a sliding as well as rotary 
motion, and can be detached from the speculum by a few turns of the 
same screw in the opposite direction, and may then be used with the 
hand as an ordinary depressor. Should the posterior wall of the 
vagina be shorter than usual, it may become necessary to loosen the 
screw G, by a turn or two, to allow the cervix to come forward into 
the field of vision. If the speculum has not been inserted deep 
enough into the vagina, the posterior wall will prolapse in front of the 
cervix. The strap ought then to be detached, the screw O to be 
loosened, and the speculum to be pushed up far enough to get 
its tip behind the cervix. While the use of the depressor is only 
occasionally required in the knee position, it is generally required in 
the lateral position, to bring the cervix into view by gentle traction 
made with it upon the anterior wall of the vagina. The knee position 
is useful when examining for ulcers or excoriations of the vagina, as 
in this position the vagina becomes distended like a balloon, enabling 
the operator to inspect the whole of its interior surface simultaneously. 
This position is represented in the wood-cut; the patient’s back ought 
to be curved downward, her knees to be separated about eight or ten 
inches, and her thighs to be at right angles with the table upon which 
she is kneeling. To expose that portion of the posterior surface of 
the vagina which is generally covered by the speculum, the largest 
size of the retractors is provided with a large fenestrum, through 
which this surface may be seen and treated. 
The special points in favor of this instrument, when compared with 
all the tubular and valvular specula, are the following: 
i. Its introduction is less difficult, and less apt to be painful. 4 
2. It permits the operator to draw the uterus forward in a line with 
the axis of the vagina, so that he may touch the cervix, and even 
explore the interior of the cervical canal with his finger, with the 
speculum in situ, while the other varieties have a tendency to push 
the uterus deeper into the pelvis, and consequently beyond the reach 
of the finger. 
3. The force necessary for the retraction of the perineum is exerted 
upon the shoulder, not against the sharp bony edge of the pubic 
arch, as is the case in a number of other specula. It can, therefore, 
be used without pain in the most muscular subject, and enables us to 
retract the perineum to its fullest extent. 
4. It exposes simultaneously a larger surface of the vagina, and 
enables us to operate through a larger and more yielding orifice, so 
that it may even be used to facilitate the introduction of pessaries. 
5. It answers for all the different vaginal or uterine operations in 
which a speculum is required, while all the others necessitate the 
possession of a variety of specula. 
When compared with Sims’ speculum, the points in its favor are ; 
that it affords all the superior advantages of this instrument, and is 
free of its principal objection—the necessity of a skilled assistant—as 
it accomplishes, by means of a very simple mechanism, all an assistant 
can do with Sims’ speculum. 
It follows all the motions of the patient, never losing its relative 
position to her body. In consequence of which it is even superior to 
Sims’ speculum when that is held by a skillful assistant, especially 
during tedious operations, as it then frequently becomes necessary 
for the operator to put down his instruments and correct the position 
of the speculum with his own hands, because he finds it next to 
impossible to convey to the assistant a description of the required 
position by any other means. 
Messrs. F. Arnold & Son, Surgical Instrument Makers, No. 
15 S. Sharp Street, Baltimore, manufacture the instrument as here 
described, and also a cheaper form, without the adjustable depressor 
and lateral movement, for the general practitioner.